Healthcare Provider Details

I. General information

NPI: 1770662033
Provider Name (Legal Business Name): SANDRA K. FAUST, PH.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 SE OSCEOLA ST
STUART FL
34994-2322
US

IV. Provider business mailing address

508 SE OSCEOLA ST
STUART FL
34994-2322
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-4190
  • Fax: 772-223-6313
Mailing address:
  • Phone: 772-463-4190
  • Fax: 772-223-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC 1474
License Number StateFL

VIII. Authorized Official

Name: DR. SANDRA KAYE FAUST
Title or Position: PRESDIENT
Credential: PH.D.
Phone: 772-463-4190